Polymyalgia rheumatica and GCA suspicion — structured viva

Structured oral on PMR and GCA: defending the clinical diagnosis and its criteria, the steroid response as a diagnostic test, the GCA emergency pathway, ultrasound and biopsy performance, the long-course steroid burden with bone protection, and steroid-sparing escalation in relapsing disease.

Prompt

The examiner opens: 'A 70-year-old can't lift her arms above her shoulders and her ESR is 80. Walk me through your consultation.' The viva branches through diagnosis, the steroid decision, the GCA screen, imaging, the long game, and relapse.

Stem

You are the GP. A 70-year-old woman presents with 5 weeks of bilateral shoulder and hip girdle pain, morning stiffness over an hour, and an ESR of 80 mm/h. ^[1]

References12Show

[1]Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative Arthritis Rheum, 2012.PMID 22389040
[2]Hellmich B, Agueda A, Monti S, et al. 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis Ann Rheum Dis, 2026.PMID 42481270
[3]Dejaco C, Ramiro S, Duftner C, et al. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review JAMA, 2016.PMID 27299619
[4]Terenzi R, Ditto MC, Benucci M, et al. Ultrasound-detected bilateral subacromial-subdeltoid bursitis exceeding 3 mm differentiates polymyalgia rheumatica from rotator cuff tendinopathy Rheumatol Int, 2025.PMID 40892101
[5]Joshi M, Liddle J, Ereira S, et al. Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review RMD Open, 2015.PMID 26535139
[6]Patel AK, Yates G, Chong V, et al. Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis Cochrane Database Syst Rev, 2024.PMID 38323659
[7]Rinagel M, Chatelus E, Jousse-Joulin S, et al. Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature Autoimmun Rev, 2019.PMID 30408588
[8]Spiera R, Kissin E, Collinson N, et al. Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper N Engl J Med, 2023.PMID 37792612
[9]Floris A, Piga M, Chessa E, et al. Long-term glucocorticoid treatment and high relapse rate remain unresolved issues in the real-life management of polymyalgia rheumatica: a systematic literature review and meta-analysis Clin Rheumatol, 2022.PMID 34415462
[10]Buckley L, Guyatt G, Fink HA, et al. 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis Arthritis Rheumatol, 2023.PMID 37845798
[11]Durez P, Vanderstockhen G, Lauwerys B, et al. Results of a 1-year randomised double-blind placebo-controlled trial with methotrexate 25 mg/week in recently diagnosed polymyalgia rheumatica Ann Rheum Dis, 2026.PMID 41423373
[12]González-Gay MA, Vicente-Rabaneda EF, Martínez-López JA, et al. Challenges in the diagnosis of polymyalgia rheumatica and related giant cell arteritis Expert Rev Clin Immunol, 2023.PMID 36896659

Polymyalgia rheumatica and GCA suspicion — structured viva

Stem

You are the GP. A 70-year-old woman presents with 5 weeks of bilateral shoulder and hip girdle pain, morning stiffness over an hour, and an ESR of 80 mm/h. ^[1]

References12Show

[1]Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative Arthritis Rheum, 2012.PMID 22389040
[2]Hellmich B, Agueda A, Monti S, et al. 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis Ann Rheum Dis, 2026.PMID 42481270
[3]Dejaco C, Ramiro S, Duftner C, et al. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review JAMA, 2016.PMID 27299619
[4]Terenzi R, Ditto MC, Benucci M, et al. Ultrasound-detected bilateral subacromial-subdeltoid bursitis exceeding 3 mm differentiates polymyalgia rheumatica from rotator cuff tendinopathy Rheumatol Int, 2025.PMID 40892101
[5]Joshi M, Liddle J, Ereira S, et al. Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review RMD Open, 2015.PMID 26535139
[6]Patel AK, Yates G, Chong V, et al. Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis Cochrane Database Syst Rev, 2024.PMID 38323659
[7]Rinagel M, Chatelus E, Jousse-Joulin S, et al. Diagnostic performance of temporal artery ultrasound for the diagnosis of giant cell arteritis: a systematic review and meta-analysis of the literature Autoimmun Rev, 2019.PMID 30408588
[8]Spiera R, Kissin E, Collinson N, et al. Sarilumab for Relapse of Polymyalgia Rheumatica during Glucocorticoid Taper N Engl J Med, 2023.PMID 37792612
[9]Floris A, Piga M, Chessa E, et al. Long-term glucocorticoid treatment and high relapse rate remain unresolved issues in the real-life management of polymyalgia rheumatica: a systematic literature review and meta-analysis Clin Rheumatol, 2022.PMID 34415462
[10]Buckley L, Guyatt G, Fink HA, et al. 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis Arthritis Rheumatol, 2023.PMID 37845798
[11]Durez P, Vanderstockhen G, Lauwerys B, et al. Results of a 1-year randomised double-blind placebo-controlled trial with methotrexate 25 mg/week in recently diagnosed polymyalgia rheumatica Ann Rheum Dis, 2026.PMID 41423373
[12]González-Gay MA, Vicente-Rabaneda EF, Martínez-López JA, et al. Challenges in the diagnosis of polymyalgia rheumatica and related giant cell arteritis Expert Rev Clin Immunol, 2023.PMID 36896659